Effects of electroacupuncture guided by the vessel-collateral theory on short-term ventricular remodeling following STEMI-PCI surgery: a randomized controlled clinical study

目的: 基于脉络学说“气虚血瘀-络塞积成”理论指导电针干预急性ST段抬高型心肌梗死（STEMI）经皮冠状动脉介入治疗（PCI）术后心室重构，并评价其临床疗效。方法: 采用前瞻性随机对照设计，纳入80例STEMI-PCI术后心功能不全（气虚血瘀证）患者，随机分为对照组（40例，脱落2例）和电针组（40例，脱落2例）。对照组给予标准化西药治疗，电针组在此基础上增加电针干预（内关、膻中、神门、气海、血海、足三里，疏密波，2 Hz/100 Hz，30 min/次，隔日1次，持续8周）。采用超声三维斑点追踪成像技术检测两组患者治疗前后心功能指标:左心室射血分数（LVEF）、左心室整体纵向应变（GLS），以及心脏结构指标:左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）;ELISA法检测患者血清中心肌纤维化标志物可溶性生长刺激表达基因2蛋白（sST2）、半乳糖凝集素-3（Gal-3）水平;免疫比浊法检测血清中心衰指标N末端B型脑钠肽前体（NT-proBNP）水平;对比两组患者治疗前后中医证候积分变化并评价治疗的安全性。结果: 与本组治疗前相比，两组治疗后的心脏功能指标、心脏结构指标、血清心肌纤维化标志物及中医证候积分均有改善（P<0.001）。与对照组相比，电针组治疗后LVEF、GLS绝对值显著增高（P<0.01，P<0.001），LVEDV、LVESV显著降低（P<0.01，P<0.001）;血清心肌纤维化标志物（sST2、Gal-3）水平显著降低（P<0.05，P<0.01）;血清心衰标记物NT-proBNP水平显著降低（P<0.001）;中医证候积分改善更显著（P<0.01，P<0.001），且无严重不良事件发生。结论: 电针可能有助于改善STEMI-PCI术后患者的心功能及心室重构指标，其作用机制可能与调节血清中心肌纤维化标志物水平有关。.; OBJECTIVES: Based on the vessel-collateral theory, "qi deficiency and blood stasis leading to collateral obstruction and accumulation", electroacupuncture was delivered in patients with ventricular remodeling after percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI), and the clinical efficacy was evaluated. METHODS: A prospective randomized controlled design was adopted. Eighty patients with cardiac insufficiency after STEMI-PCI (qi deficiency and blood stasis) were enrolled and randomly assigned to a control group (40 cases, with 2 cases dropped out) and an electroacupuncture group (40 cases, with 2 cases dropped out). In the control group, the standardized western medication was administered. In the electroacupuncture group, on the basis of the regimen as the control group, electroacupuncture was operated at Neiguan (PC6), Danzhong (CV17), Shenmen (HT7), Qihai (CV6), Xuehai (SP10) and Zusanli (ST36) with dense-disperse wave, at a frequency of 2 Hz/100 Hz, 30 min per session, once every other day, for 8 consecutive weeks. Three-dimensional speckle tracking echocardiography was used to detect cardiac function indicators:left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS), and cardiac structural indicators:left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) in both groups before and after treatment. ELISA was used to detect the serum levels of cardiac fibrosis markers:soluble suppression of tumorigenicity 2 (sST2) and galectin-3 (Gal-3);immunoturbidimetry was used to detect the heart failure marker:N-terminal pro-B-type natriuretic peptide (NT-proBNP). Changes in traditional Chinese medicine (TCM) syndrome scores were compared and the safety was evaluated in the two groups. RESULTS: Compared with the control group, the electroacupuncture group showed the increase in LVEF and absolute value of GLS (P<0.01, P<0.001) and the decrease in LVEDV and LVESV (P<0.01, P<0.001) after treatment;serum fibrosis markers (sST2, Gal-3) levels were reduced (P<0.05, P<0.01), the serum heart failure marker (NT-proBNP) level was decreased (P<0.001), and the scores of TCM symptoms were improved (P<0.01, P<0.001). Gompared with before treatment, both groups showed improvement (P<0.001) in the above indicators after treatment. No serious adverse event was reported. CONCLUSIONS: Electroacupuncture may conduce to ameliorating cardiac functions and ventricular remodeling indicators in patients after STEMI-PCI, which is probably related to the modulation of cardiac fibrosis markers in serum.